4. TRAUMA EMERGENCIES
4.5 MULTI-SYSTEMS TRAUMA
Multi-systems trauma is a leading cause of death and disability . Trauma victims require definitive surgical intervention to repair and/or stabilize their injuries in order to enhance survival and reduce complications. Successful management of trauma victims will require rapid assessment, stabilization and transportation to an appropriate trauma center as defined by regional point of entry guidelines. Activate air transport services as appropriate.
Multiple trauma victims are identified by the history of the incident in which serious injury can occur as well as the physiologic alterations that an individual suffers. Many injuries are occult and one must be careful not to be fooled by obvious external injuries which ultimately prove to be less serious than hidden internal disorders. Physiologic alterations may not occur immediately post-injury. However, once they develop, they may lead to shock and death within a few minutes. About one liter of further blood loss converts a stage II hemorrhage with minimal abnormalities of vital signs to a stage IV hemorrhage with refractory shock and inevitable death. Proper, timely interventions may well prevent this occurrence.
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. Assume spinal injury when appropriate and treat accordingly.
3. Administer high flow oxygen by non-rebreather mask or bag valve mask as determined by patient's condition.
4. Determine patient's hemodynamic stability and symptoms. Continually assess Level of Consciousness, ABCs and Vital Signs. Treat all life threatening conditions as they become identified.
5. When multiple patients are involved, they need to be appropriately triaged.
6. Obtain appropriate history related to event, including Past Medical History, Medications, Drug Allergies, Substance abuse.
7. Patient care activities must not unnecessarily delay patient transport to an appropriate facility.
8. If the scene time and/or transport time will be prolonged, and a landing site is available, consider transport by air ambulance from the scene to an appropriate Trauma Center. See Air Ambulance protocol.
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization. Airway may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration oxygen by non-rebreather mask as determined by patient's condition.
4. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
5. Activate ALS intercept, if deemed necessary and if available.
6. Patient care activities must not unnecessarily delay patient transport to an appropriate facility.
7. For hemodynamically unstable patients with suspected pelvic fracture(s), contact MEDICAL CONTROL for potential utilization of PASG/MAST.
8. Initiate transport as soon as possible with or without ALS.
9. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization. Airway may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration oxygen by non-rebreather mask as determined by patient's condition.
4. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
5. Activate Paramedic intercept, if deemed necessary and if available.
6. Patient care activities must not unnecessarily delay patient transport to an appropriate facility.
7. ALS STANDING ORDERS
a. Provide advanced airway management if indicated.
b. Initiate 1-2 IVs Normal Saline while in transport (titrated to patient’s condition), or during extrication procedures.
c. For hemodynamically unstable patients with suspected pelvic fracture(s), utilization of PASG/MAST.
8. Contact MEDICAL CONTROL. The following may be ordered:
a. IV Normal Saline 250 cc -500 cc bolus or wide open titrated to patient's condition.
9. Initiate transport as soon as possible with or without ALS.
10. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization. Airway may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration oxygen by non-rebreather mask as determined by patient's condition.
4. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
5. Patient care activities must not unnecessarily delay patient transport to an appropriate facility.
6. ALS STANDING ORDERS
a. Provide advanced airway management if indicated.
b. Initiate 1-2 IVs Normal Saline while in transport (titrated to patient’s condition), or during extrication procedures.
c. Application/inflation of PASG/MAST (if indicated)
7. Contact MEDICAL CONTROL. Medical control may order:
a. IV Normal Saline 250 cc - 500 cc bolus or wide open titrated to patient's condition.
b. Specific procedures as indicated (i.e. chest decompression, needle cricothyroidotomy)
8. Initiate transport as soon as possible.
9. Notify receiving hospital
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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